Efficacy of intrathecal bupivacaine: how important is the flow rate?

Pain Medicine : the Official Journal of the American Academy of Pain Medicine
Eric BuchserJean-Pierre Mustaki

Abstract

We present two cases of cancer patients with intractable mechanical and visceral pain that was unrelieved with either comprehensive medical management or intrathecal morphine who received intrathecal bupivacaine. While the continuous administration of a seemingly significant daily dose neither relieved pain nor caused measurable clinical changes, the addition of small, presumably negligible bolus doses on top of the continuous infusion resulted in spectacular pain control, clear thermoanalgesic suspended block, and in one of the patients, significant hypotension. To the best of our knowledge, such an observation has neither been reported before nor can we provide a satisfactory explanation for it. However, we believe it may have significant implications for the treatment of some patients, in particular, cancer patients with mechanical pain that cannot be adequately relieved with morphine whatever the route of administration.

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Citations

Nov 17, 2006·Der Schmerz·R LikarM C Spendel
Apr 13, 2012·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
Aug 2, 2012·Neuromodulation : Journal of the International Neuromodulation Society·Timothy R DeerNagy Mekhail
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Feb 10, 2016·Neuromodulation : Journal of the International Neuromodulation Society·Tim ReckUlrich Kallenbach
Feb 22, 2011·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Anton Adriaan van der PlasJacobus Johannes van Hilten
Apr 6, 2011·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Christophe PerruchoudEric Buchser
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Jun 29, 2021·Neuromodulation : Journal of the International Neuromodulation Society·Florent BienfaitDenis Dupoiron

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